Evaluation of Clinically Meaningful Changes in Measures of Frailty

Jang, Il‐Young; Jung, Hee-Won; Lee, Hea Yon; Park, Hyungchul; Lee, Eun‐Ju; Kim, Dae

doi:10.1093/gerona/glaa003

Cited by 59 publications

(54 citation statements)

References 27 publications

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“…Previous work using cross‐sectional data estimated that deficit accumulation occurs at a rate of 3% per year on a logarithmic scale 19 . A recent study suggested that a change in FI of 0.03 was sensitive to detect small changes in EuroQol‐5D, a global measure of health status 15 . Another study compared frailty measurements from different time points, concluding that the most recent frailty measurement was a better predictor of mortality 16 .…”

Section: Discussionmentioning

confidence: 99%

“…Change in frailty was calculated as the difference in FI from Round 1 to Round 2; thus, a positive change indicates increasing deficits and worsening frailty. Prior literature on change in FI has suggested that the minimally clinically important difference in FI is 0.03 15 . However, some studies have also examined change as a percentage of baseline frailty level 16 .…”

Section: Methodsmentioning

confidence: 99%

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Changes in a Frailty Index and Association with Mortality

Shi

Olivieri‐Mui

McCarthy

et al. 2020

J American Geriatrics Society

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Background Although frailty status is dynamic, whether improvements in frailty predict mortality is unknown. Objective Describe 1‐year changes in a frailty index (FI) and association with 48‐month mortality. Design Secondary analysis of the National Health in Aging Trends Study. Setting Community. Participants Five thousand six hundred and seventy two Medicare beneficiaries 65 and older (3,267 (55.8%) females). Measurements A 40‐item deficit accumulation FI was measured in 2011 and 2012, based on multidomain assessment including comorbidities, activities of daily living, physical tasks, cognition, and performance testing. We categorized 2011 FI into robust (FI < 0.15), pre‐frail (FI = 0.15–0.24), mild frailty (FI = 0.25–0.34), and moderate to severe frailty (FI ≥ 0.35). Change in frailty was calculated as the FI change from 2011 to 2012, categorized as either absolute (>0.045 decrease, 0.015–0.045 decrease, ±0.015 change, 0.015–0.045 increase, >0.045 increase) or proportional change (>20% decrease, 5–20% decrease, ±5% change, 5–20% increase, 20% increase). We measured the association of FI change with 4‐year mortality using Cox regression. Results From 2011 to 2012, mean FI increased by 0.02 (standard deviation 0.07), with 58.6% having an increase. Over 4 years, 1,039 participants (13.6%) died. After adjusting for age and sex, compared to stable frailty (±0.015), both absolute (>0.045) and proportional (>20%) increases in frailty were associated with higher mortality among pre‐frail participants (hazard ratio (HR) = 2.35, 95% confidence interval (CI) = (1.45–3.79) and HR (95% CI) = 3.32 (1.76–6.26), respectively), participants with mild frailty (HR (95% CI) = 1.96 (1.35–2.85) and 2.03 (1.37–3.02)) and moderate or severe frailty (HR (95% CI) = 1.99 (1.48–2.67) and 1.94 (1.43–2.63)) but not robust participants (HR (95% CI)= 1.48 (0.86–2.54), HR (95% CI) = 1.62 (0.80–3.28)). However, decreases in FI were not significantly associated with decreased risk of mortality. Conclusions Increasing deficit accumulation FI over 1 year is associated with increased mortality risk. While decreasing FI occurs, we did not find evidence to support reduced mortality risk.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Changes in a Frailty Index and Association with Mortality

Shi

Olivieri‐Mui

McCarthy

et al. 2020

J American Geriatrics Society

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“…Health deficits accumulate at a slower rate in mid-life than at older ages [27] and frailty measured in younger populations might be clinically and biologically different from that measured in older populations[l]. Nonetheless, our measure of frailty is particularly suited to mid-life because it has demonstrated good construct validity at this life stage[45] and it provides a continuous score of fitness to frail [24] allowing detection of small differences in health compared to other measures[26]. Finally, as with all long-term studies, attrition occurred over time.…”

Section: Discussionmentioning

confidence: 99%

“…This index considers the accumulation of health-related deficits[24,25], and is a validated and commonly used approach to operationalising frailty. Compared with other frailty measures, the FI is more sensitive to small changes in health status[26] making it particularly suitable for examining frailty in mid-adulthood, a life-stage when health deficits are accumulating at a slower rate than at older ages [27].…”

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confidence: 99%

Early-life socioeconomic position and the accumulation of health-related deficits by midlife in the 1958 British birth cohort study

Rogers

Blodgett

Searle

et al. 2020

Preprint

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Reducing population levels of frailty is an important goal and preventing its development in mid-adulthood could be pivotal. Childhood socioeconomic position (SEP) is associated with a myriad of adult health outcomes but evidence is limited on associations with frailty. Using 1958 British birth cohort data (N=8711), we aimed to: (i) establish the utility of measuring frailty in mid-life, by examining associations between a 34-item frailty index at 50y (FI50y) and mortality over an eight-year follow-up period and (ii) examine associations between early-life SEP and FI50y and investigate whether these associations were explained by adult SEP. Hazard ratios (HRs) for mortality increased with increasing levels of frailty, e.g., HRsex-adjusted was 4.07(95% CI:2.64,6.25) for highest vs. lowest fifth of FI50y. Lower early-life SEP was associated with higher FI50y: per unit decrease in early-life SEP (on a 4-point scale), FI50y increased by 12.7%(10.85%,14.6%) in a model adjusted for early-life covariates. After additional adjustment for adult occupational class and education, the association attenuated to 5.71%(3.71%,7.70%). Findings suggest that early-life SEP is associated with frailty and that adult SEP only partially explains this association. Results highlight the importance of improving socioeconomic circumstances across the life course to reduce inequalities in frailty from mid-adulthood.

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“…We evaluated depressive mood using the Korean version of the CES‐D (range: 0–60) and defined depression as a CES‐D score ≥21 24,25 ; cognitive function using the Korean MMSE 26 ; and malnutrition using the Mini‐Nutritional Assessment Short Form (MNA‐SF) (range: 0–14). Frailty was assessed according to the frailty phenotype scale (range: 0–5) based on unintentional weight loss, exhaustion, inactivity, slow gait speed, and weak grip strength, 27 as well as a deficit‐accumulation frailty index (range: 0–1) based on 43 health deficit items (38 self‐reported items and five performance test items) 28‐30 …”

Section: Methodsmentioning

confidence: 99%

Multicomponent Intervention and Long‐Term Disability in Older Adults: A Nonrandomized Prospective Study

Park

Lee

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES To evaluate the long‐term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN This was a nonrandomized prospective intervention trial. SETTING The setting was a community. PARTICIPANTS Participants included older Koreans living alone or receiving government assistance from a low‐income program. INTERVENTION The intervention was a 24‐week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0–17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS The study population had a mean age of 76 years, and 26% were men. During the 30‐month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION A 24‐week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.

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Evaluation of Clinically Meaningful Changes in Measures of Frailty

Cited by 59 publications

References 27 publications

Changes in a Frailty Index and Association with Mortality

Changes in a Frailty Index and Association with Mortality

Early-life socioeconomic position and the accumulation of health-related deficits by midlife in the 1958 British birth cohort study

Multicomponent Intervention and Long‐Term Disability in Older Adults: A Nonrandomized Prospective Study

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